Government and Regulations

Forget Privatization, How About Better Integration for Federal Health Care?

Public health experts propose 5 ways to better integrate fragmented federal health care programs to increase efficiency and enhance the beneficiary experience.


Even as the Commission on Care considers ways to change VA health care, a Viewpoint published in the June 2016 issue of JAMA argues that integrating federal health care systems would be more efficient and provide better care. About $1.3 trillion is spent annually on more than 100 million beneficiaries who receive health care services from the VA, DoD, PHS, Medicare, Medicaid, and other federal health care programs. “A more integrated federal health system would, above all, improve the beneficiary experience,” wrote Dhruv Khullar, MD, MPP, of Massachusetts General Hospital and Dave A. Chokshi, MD, MSc, of New York University Langone Medical Center. “Individuals would enroll in fewer programs, with greater harmonization of policies and procedures.”

Dr. Chokshi and Dr. Khullar propose 5 changes, though they admit that “many of these proposals will require significant administrative action and cooperation among government branches.” As the authors note, the Captain James A. Lovell Federal Health Care Center in Chicago, Illinois, has already showcased some of this integration.

The first proposal is to minimize overlapping service delivery and procurement. As the authors note, 42 separate programs in 6 different federal departments offer nonemergency medical transportation service. However, drug procurement could be the true opportunity for cost savings. “Joint procurement efforts for drugs, as well as for medical and surgical supplies, could result in significant savings,” they argue.

Adopting technology systems that talk to each other is a second important step. “At minimum, federal agencies should lead the adoption of these standards in their own EHRs—just as the VA and Centers for Medicare & Medicaid Services led in ensuring that patients could access their own electronic health data,” the authors insist. Both the VA and DoD already have taken significant steps toward ensuring their electronic health record systems are able to share data.

Other suggestions included repurposing underutilized facilities for use by other health care programs, expanding value-based purchasing, and reducing duplicate payments. As the authors point out more than 1 million beneficiaries use both the Medicare Advantage and the VA systems.

Better integration could make the system more efficient and improve beneficiary care, the authors argue. “Improved communication across agencies, ideally through an integrated health record, would ensure that patients receive more seamless care; that clinicians could more readily access medical histories and provide comprehensive services; and that government programs could more effectively manage the health of the populations they serve.”

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